Systemic Autoimmune Conditions Increase Hospitalization Risk in COVID-19

Doctors speaking with COVID19 patient in ICU
Researchers described patients with autoimmune inflammatory rheumatic diseases with COVID-19 and the risk factors associated with hospitalization related to COVID-19.

Systemic autoimmune conditions and age, but not treatment with disease-modifying antirheumatic drugs (DMARDs), may be risk factors for hospitalization related to coronavirus disease 2019 (COVID-19), according to study data published in the Annals of the Rheumatic Diseases.

The observational longitudinal study enrolled patients with an autoimmune inflammatory rheumatic disease (AIRD) diagnosis and laboratory-confirmed COVID-19 infection who received care at the rheumatology clinic of a tertiary hospital in Madrid, Spain. Demographic, clinical, and laboratory data were collected by medical record review. Hospitalization data were collected during the pandemic peak of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in Spain, between March 1, 2020 and April 24, 2020. The primary outcome was hospital admission related to COVID-19. Multivariable logistic regression was performed to identify risk factors for hospitalization among patients with AIRD. Models were adjusted for demographic characteristics, type of AIRD, baseline comorbid conditions, and the use of anti-inflammatory treatment.

The study population included 123 patients with AIRD and symptomatic COVID-19, among whom 86 (69.92%) were women. A total of 24 patients (44.4%) had systemic autoimmune conditions, while the remaining had chronic inflammatory arthritis. Mean age was 59.88±14.9 years; mean time since AIRD diagnosis was 10.65±8.31 years. The most common diagnosis was rheumatoid arthritis (40.65%), followed by axial spondyloarthritis (14.63%). Overall, 54 patients (43.90%) were hospitalized due to COVID-19.

In univariable analyses, older age was associated with significantly increased risk for hospitalization (odds ratio [OR], 1.09; 95% CI, 1.05-1.14, P =0). Women compared with men were at significantly lower risk for hospitalization (OR, 0.4; 95% CI, 0.18-0.988; P =.02). Hypertension and lung disease also increased risk for hospitalization. In multivariate analyses, age (OR, 1.08; 95% CI, 1.04-1.13; P =0), and systemic autoimmune conditions (OR, 3.55; 95% CI, 1.30-9.67; P =.01) were observed to be significant risk factors for hospitalization. The use of DMARDs and glucocorticoids did not increase risk for hospitalization.

In this study of a real-world hospital setting, 44% of patients with AIRD and COVID-19 required hospital admission. Hospitalization risk was particularly pronounced in older patients and those with systemic autoimmune conditions. Treatment with DMARDs was not associated with hospitalization, despite their immunosuppressing and/or immunomodulatory effects.

As study limitations, investigators cited the small cohort size, the use of a single center, and that data may not be generalizable to other patients with AIRD.

“[W]e consider our findings helpful to increase the knowledge and management of patients with AIRD and COVID-19,” the investigators concluded.


Freites Nuñez DD, Leon L, Mucientes A, et al. Risk factors for hospital admissions related to COVID-19 in patients with autoimmune inflammatory rheumatic diseases. Published online August 7, 2020. Ann Rheum Dis. doi:10.1136/annrheumdis-2020-217984